支气管镜引导下经支气管针吸活检术与纵隔镜在肺癌及纵隔肿物诊断中的比较

摘要

Objective To evaluate the clinically applied value and safety between mediastinoscopy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with mediastinal masses and lung cancers.Methods The clinical data of 152 cases receiving EBUS-TBNA examination (118 cases of lung cancers and 34 cases of mediastinal masses of unknown origin),and those of 174 cases subject to mediastinoscopy examination (130 cases of lung cancers and 44 cases of mediastinal masses of unknown origin) admitted at Xuzhou Central Hospital from January 2015 to January 2017 were summarized.The diagnostic results and related indicators of two methods were compared.Results Taking pathology diagnosis as the gold standard,the accuracy,sensitivity and specificity of EBUS-TBNA and mediastinoscopy in the diagnosis and staging of lung cancers were 94.47％,93.32％ and 100.00％,and 95.98％,94.62％ and 100.00％ respectively.Two techniques in the diagnosis and staging of lung cancers had no statistically significant difference (P =0.071).The accuracy,sensitivity and specificity of EBUS-TBNA and mediastinoscopy in the diagnosis of mediastinal masses were 90.79％,58.82％ and 100.00％,and 95.40％,81.82％ and 100.00％ respectively.Two techniques in the diagnosis of mediastinal masses had statistically significant difference (P =0.026).Besides,as compared with mediastinoscopy,the EBUS-TBNA procedure was uneventful without complications.Conclusion EBUS-TBNA is a safe and effective method in the diagnosis and staging of lung cancers.It is expected to gradually replace mediastinoscopy as the gold standard for accurate staging of lung cancers.%目的 探讨超声支气管镜引导下经支气管针吸活检术(EBUS-TBNA)与纵隔镜诊断效能及安全性.方法 胸部肿瘤患者共326例,其中进行EBUS-TBNA检查的患者152例,包括肺癌118例,纵隔肿物34例;进行纵隔镜检查术患者174例,包括肺癌130例,纵隔肿物44例.比较两种检查方法对肺癌及纵隔肿物的敏感性、特异性及并发症的发生率.结果 以病理学诊断为金标准,EBUS-TBNA对于肺癌诊断的准确性为94.47％,敏感性为93.32％,特异性为100.00％;纵隔镜检查术的诊断准确性为95.98％,敏感性为94.62％,特异性为100.00％.两者对肺癌的诊断和分期效能差异无统计学意义(P=0.071).EBUS-TBNA对于纵隔肿物诊断的准确性为90.79％,敏感性为58.82％,特异性为100.00％;纵隔镜检查术的诊断准确性为95.40％,敏感性为81.82％,特异性为100.00％.纵隔镜对纵隔肿物的诊断效能较高(P =0.026).EBUS-TBNA较纵隔镜安全,无明显严重并发症.结论 在以肺癌为主的胸部肿瘤的精确诊断分期中,EBUS-TBNA是一种安全的新型微创诊断技术平台,具有较高的灵敏度、特异性和准确性.